局部筋膜瓣联合植皮对头面部骨外露创面的修复效果观察

The effect of local fascial flap combined with skin grafting on craniofacial bone exposed wound repair in patients with craniofacial bone exposed wound

目的探讨局部筋膜瓣联合植皮对头面部骨外露创面的修复效果。方法选取山西省运城市中心医院2016年1月至2021年9月收治的60例头面部骨外露创面患者,根据治疗方法的不同分为观察组和对照组,每组30例。对照组接受传统的筋膜瓣反转修复,观察组采用局部筋膜瓣联合植皮修复。术后随访6个月,比较两组的筋膜瓣成活率、皮片成活率、创面修复效果、美容温哥华瘢痕量表(Vancouver scar scale,VSS)评分、疼痛视觉模拟量表(visual analogue scale,VAS)评分及不良反应发生情况。结果观察组筋膜瓣成活率和皮片成活率高于对照组,创面臃肿发生率低于对照组,红期进入时间和创面愈合时间短于对照组,差异均有显著性(P<0.05)。观察组治疗有效率为100.0%,明显高于对照组的66.7%,差异有显著性(P<0.05)。术后1、3、6个月,观察组VSS评分均明显低于对照组(P<0.05)。术后1、3、7d,观察组VAS评分均明显低于对照组(P<0.05)。观察组不良反应发生率为23.3%,明显低于对照组的56.7%,差异有显著性(P<0.05)。结论局部筋膜瓣联合植皮对头面部骨外露创面具有较好的修复效果,可提高筋膜瓣成活率和皮片成活率,降低创面臃肿发生率、VSS评分及VAS评分,且不良反应发生率较低,值得临床应用。

Objective To investigate the repair effect of local fascia flap combined with skin grafting on head and face bone exposed wound.Method A total of 60 patients with head and facial bone exposure wounds admitted to Yuncheng Hospital Affiliated to Shanxi Medical University from January 2016 to September 2021 were selected and divided into observation group and control group according to different treatment methods,with 30 patients in each group.The control group received traditional fascial flap reversal repair,and the observation group received local fascial flap combined with skin graft repair.The fascial flap survival rate,skin slice survival rate,wound repair effect,Vancouver Scar Scale(VSS)score,visual analogue scale(VAS)score and the occurrence of adverse reactions were compared between the two groups at 6 months postoperative follow-up.Result The fascial flap survival rate and skin survival rate in the observation group were higher than those in the control group,and the wound swelling rate was lower than that in the control group,and the red phase entry time and wound healing time were shorter than those in the control group(P<0.05).The effective rate of observation group was 100.0%,which was significantly higher than that of control group(66.7%,P<0.05).VSS score of observation group was significantly lower than that of control group at 1,3 and 6 months after operation(P<0.05).On day 1,3 and 7 after surgery,VAS score of observation group was significantly lower than that of control group(P<0.05).The incidence of adverse reactions in the observation group was 23.3%,which was significantly lower than that in the control group(56.7%),and the difference was significant(P<0.05).Conclusion Local fascia flap combined with skin graft has a good repair effect on the head and face bone exposed wounds,which can improve the fascia flap survival rate and skin survival rate,reduce the wound swelling rate,VSS score and VAS score,without bringing additional harm to patients,which is worthy of clinical application.